Wiki Drug Testing for Oral Fluid instead of Urine

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tinawhittler

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I'm with an SIU and we are consistently seeing labs that are billing for Oral Fluid Drug Testing using the G0480-G0483 series codes. Does anyone have a better code recommended for billing using Oral Fluid drug testing in both Pain Management and Substance Abuse?

We usually follow Medicare Guidelines and our Policy is based on the LCD for UDT's and we are having difficulty finding any guidance surrounding Oral Fluids as LCD L36393 only mentions Oral Fluid in a very general sense, everything is aimed directly at urine. There are no specific CPT or HCPCs codes mentioned as appropriate to be used for Oral Fluid testing or guidance.

We did locate 0011U-Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites. This is listed as a PLA code but I'm not entirely sure what would be required to verify that the lab performing this service is properly set up to perform this service.

Any help would be greatly appreciated.
 
This is a difficult one because the G0480-G0483 code descriptions do not specify urine, but the LCD is only referring to Urine Drug Screening. I would say possibly that the individual CPT codes 80320-80377 would work in a definitive setting, but following Medicare guidelines would redirect back to the G codes. I would just ask the question why they are using oral fluid over urine. I wish I had a better answer.
 
The CPT coding definitions for definitive drug testing include urine, oral, blood, CSF. You should not use any of the PLA codes (011U) that are specific to a particular laboratories test method and result expression. The reason that oral fluid isn't mentioned is because it is a really difficult matrix to test, specifically during the pre-analytical phase where the sample needs to be extracted from the collection device. There is also not a one to one correlation between what you can test for in urine vs. oral fluid. Urine is the gold standard for this testing, oral while helpful for patient's who are problematic, or have tampered with specimens previously.

AMA codes 80320-80377 or G0480-G0483 are all appropriate for oral fluid definitive drug testing. The one caveat with oral fluid is that most labs have not validated an ELISA method for presumptive screening, so you have the test going direct to definitive. Meaning you, as a SIU- you will not see presumptive screening results, meaning alot more G0482 and G0483's because testing of benzodiazepines, opiates, THC, Cocaine as example will go direct to the definitive rather than being screened first.

Hope that helps!!
 
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